Southern California Alcohol and Drug Programs Inc

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					            Southern California Alcohol and Drug Programs Inc.
                           Needs Assessment Report

                                      September 3, 2008

I. Introduction

A. Purpose of the needs assessment:

The purpose of the needs assessment is to provide SCADP with a clear picture of the
women who will be the target participants for the Parent-Child Assistance Program (P-
CAP) and of the service delivery system into which the intervention will be integrated.
This document will guide the development of services responsive to the needs of our
population and the implementation of the evidence-based P-CAP.

B. Goals of this initiative:

   1) To achieve abstinence from alcohol while pregnant and postpartum;
   2) To increase use of effective methods of contraception;
   3) To prevent future alcohol-exposed pregnancies.

C. The selected service delivery to integrate new practices:

Southern California Alcohol and Drug Programs, Inc. (SCADP) is a multi-site,
community-based nonprofit organization that has provided outpatient and residential
addiction treatment for disadvantaged and underserved populations in Los Angeles and
Orange Counties since 1972. Our continuum of care includes a static capacity of 500
residential addiction treatment beds. Four hundred of those treatment beds are
dedicated to pregnant and parenting women and children. SCADP recognized that lack
of childcare was a barrier to women seeking treatment, and in 1985 SCADP opened
Foley House - the first Southern California addiction treatment agency to allow children
to live in residence with their mothers. Since then, SCADP has opened several
women’s programs, including a domestic violence division and a residential program
specifically targeting pregnant and parenting women. The agency currently serves a
minimum of 1,600 women each year who are at high risk for giving birth to a child with
Fetal Alcohol Spectrum Disorders (FASD). Approximately 92% of the women served by
SCADP have used alcohol and other drugs during their pregnancies, and 2% of these
women have given birth to children diagnosed with an FASD in their lifetime.

SCADP will integrate the P-CAP model into our network of women’s residential
treatment and outpatient programs. SCADP programs are dedicated to the prevention
and treatment of substance abuse and other related problems. The goal is to provide
high-risk individuals with the personal tools needed to prevent and reduce addiction
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relapse and improve the quality of their lives and the lives of their children. SCADP
residential programs provide culturally-appropriate intensive counseling, case
management, life skills and mental health services.         SCADP maintains strong
relationships with other local care providers to offer an array of services that
comprehensively address the health and well-being of our participants and their
families. Women and children in a SCADP residential treatment program live in a
home-like environment for four to six months. Treatment interventions for the women
and the children are based on careful assessment. Extended family members are often
invited to participate in family groups and special activities such as picnics and
graduations.     The treatment programs are well integrated into their home
neighborhoods with established service partnerships with other service providers
including local public schools and community health clinics. Most SCADP program
directors have served their communities for many years.

SCADP programs are funded at both the local and federal levels. This provides us with
a strong programmatic base from which to provide a continuum of care. We hold
contracts with the L.A. County Alcohol and Drug Program Administration to provide
addiction treatment for pregnant and parenting women as well as contracts with the
California Department of Maternal, Child, and Adolescent Health, L.A. County
Community and Senior Services and the City of Los Angeles Department of Community
Development provide domestic violence services.        SCADP also holds several
SAMHSA/Center for Substance Abuse Treatment grants that fund treatment services
for pregnant and parenting women, including those at high risk for or HIV/AIDS and
those who are dually diagnosed with substance abuse and mental health disorders.

Participants will be screened and selected for P-CAP by P-CAP staff while enrolled at
one of the following SCADP treatment programs in Los Angeles and Orange Counties:

      Angel Step Inn (10 beds). Established in 1995, Angel Step Inn (ASI) is an
       emergency shelter serving homeless, substance-addicted battered women and
       their children. ASI was the first emergency domestic violence (DV) shelter
       program in California to admit women suffering from both domestic violence and
       addiction. Located in Whittier, CA (LA County).

      Angel Step Too (36 beds). Established in 1997, ASToo is a transitional shelter
       serving homeless, substance-addicted battered women and their children.
       Located in Bellflower, CA (LA County).

      Awakenings (14 beds).       Established in 1988, Awakenings was the first
       emergency/transitional treatment program in the United States for and by Deaf
       and Hard of Hearing persons serving homeless, substance-addicted men and
       women and their children. Located in Whittier, CA (LA County).

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      Bud and Marcie House (9 beds). Established in 2001, Bud and Marcie’s is a
       transitional shelter serving homeless, substance-addicted pregnant and
       parenting women and their infants/children. Located in Whittier, CA (LA County).

      Casa Libre (15 beds). Established in 1995, Casa Libre is a transitional shelter
       serving homeless, substance-addicted pregnant and parenting Latinas and their
       infants/children. Located in the city of Los Angeles, California.

      Foley House (30 beds). Established in 1985, Foley House is an emergency
       shelter serving homeless, substance-addicted pregnant and parenting women,
       their infants/children. Located in Whittier, CA.

      Heritage House (36 beds) and       Heritage House North (44 beds). Established in
       1992 and 2000 respectively,        the Heritage House programs were the first
       residential treatment facilities    for women and children in Orange County.
       Heritage House is located in       Costa Mesa, CA and HH North is located in
       Anaheim, CA.

      La Casita (30 beds). In 1996, La Casita began as a bilingual and bicultural
       demonstration project funded by SAMHSA to provide substance abuse
       treatment, counseling, vocational assistance and case management to pregnant
       and parenting Latinas and their infants/children. Located in Downey, CA.

      Positive Steps (20 beds), is a HIV/AIDS shelter in Downey, California serving
       homeless, substance-addicted women living with, or at high risk for, HIV/AIDS
       and their infants/children since 1996.

      Shelter Plus Care Tenant-Based Rental Assistance/Permanent Housing Program
       (220 units), housed in the SCADP administration building located in Downey,
       California; provides permanent housing assistance for homeless, substance-
       addicted pregnant and parenting women and their infants/children.

Each of these SCADP residential programs has an aftercare component that meets
weekly to offer ongoing peer support. For example, Foley House has a ―big sister‖
alumni group that provides support to those in early recovery. The alumni group also
provides drug- and alcohol-free social activities in the form of pancake breakfasts and
family picnics. This big sister group will be part of the support framework available to P-
CAP participants.

After women complete a primary residential treatment program, SCADP offers
transitional housing as an intermediate step or permanent housing placement either
through our Shelter Plus Care program or an extensive housing referral network.
Shelter Plus Care will be a pivotal part of the service delivery implementation because
the long-term S+C program facilitates the ability to monitor and follow-up with P-CAP
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At every step along the SCADP Continuum of Care, clients have positive role models
who understand the difficulties that women experience when in recovery and raising
children. Many SCADP staff members throughout the organization are in recovery
themselves. SCADP believes that such relationships are fundamental to the recovery

A 2007 Rand study of completion rates for residential addiction treatment programs in
Los Angeles County found that completion rates for African Americans was 30.7% and
for Whites (including Latinos) was 46.1%. 2007 residential completion rates for
SCADP’s residential treatment programs for women and children are above these
numbers (Foley House = 62%, Angel Step Too = 74%, HH North = 71%). Staff reports
that child reunification is a great incentive to complete treatment. P-CAP facilitates
continued focus on the parent-child relationship, which is a foundation of the SCADP
treatment programs. Long-term client advocacy will provide the support for relapse
prevention as the challenges and issues change in the client’s life and the life of the
client’s children. After treatment, families require support for a different set of needs.
Relationships and financial situations change. The children enter into different stages of
development that can be difficult for the mother. For example, when the children are
exposed to drugs in schools, the mother often needs support and guidance to deal
effectively with her fears for her children.

SCADP’s programs provide a foundation that we can build upon with P-CAP.

P-CAP will improve inter-program communication, which can be a challenge for our
multi-site agency. SCADP holds monthly Managers Meetings to provide an opportunity
for program directors to meet with the Executive Director and share observations and
concerns. Program staffs frequently rely on one another for information and resources.
The cross site communication required by the P-CAP model will strengthen
relationships between treatment programs.

D. Population to be served

The women selected to take part in P-CAP are pregnant and post-partum women
considered high-risk for alcohol and substance abuse. FASD are directly associated
with drinking during pregnancy – a risk factor common to 92% of SCADP’s female
clients. The majority of pregnant participants report little to no prenatal healthcare prior
to intake. Many stated they were either oblivious to, or in denial of, their pregnancy until
they felt the fetus move. Over 57% of our target populations are Latina--the ethnicity
with the highest birthrate in Los Angeles County, as well as the group most likely to live
in poverty, lack healthcare insurance, or lack a high school diploma.

In Los Angeles County, 45% of all women self-report that they consume alcohol, 2%
report chronic drinking and 16% report binge drinking. They report little knowledge of
the numerous social services available; however, they appear willing to make positive
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lifestyle decisions relating to drinking and safe sex practices that will minimize the risks
of having a child with an FASD. They come from low-income urban neighborhoods and
homes with strong religious beliefs that often attach shame to the act of seeking help
outside the family and discourage the use of contraceptives.

According to the 2005-2006 SCADP annual report, 100% of our female population lives
at or below poverty level, and 46% of females in residential treatment admitted to
drinking during the first trimester of pregnancy. Additionally, the National Institute of
Health indicates that only 39% of women of childbearing years have knowledge of
FASD. Heavy drinking is more likely to cause damage to female anatomy than similar
amounts in males, and high levels of alcohol consumption increase a woman’s risk of
becoming a victim of abuse (National Institute of Alcohol Abuse and Alcoholism
[NIAAA], 2005). Heavy drinking is more common among women who have never
married, are living unmarried with a partner, or are divorced or separated (NIAAA,

The majority of the women enrolled in SCADP residential programs are single and of
childbearing age. Many have experienced childhood sexual abuse, which puts them at
high risk for heavy drinking as noted by the National Institute of Alcohol Abuse and
Alcoholism (NIAAA, 2005). Many of them are suffering from PTSD as a result of
domestic violence or street violence within their communities.

II. Methods

A. Data collection methods and sources

In order to address the assessment questions listed in section B, we gathered data

1. The 2006-2007 SCADP annual report. This demographic information provides a
snapshot of our population.

These statistics are compiled from monthly demographic reports collected from each
treatment program. The data in the tables below were collected from the women’s
residential treatment programs listed in section 1.C.

2. Focus groups. This allowed program participants and staff to share their experiences
and express their needs.

Two large focus groups (Focus Group #1 & Focus Group #2) were held at the SCADP
administration building, and several small groups (Satellite Focus Groups) were held at
SCADP program sites. The focus group questions were designed to elicit the needs
and concerns of our target population so we could the address the overarching needs
assessment questions.
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The data from the focus groups was compiled from:

       1.) Verbal responses to questions recorded during two focus group sessions
       held at SCADP administrative offices, and

       2.) Responses to questions and discussion at three satellite focus groups held at
       treatment program sites - two residential programs and one outpatient program.
       Written questions were provided in the treatment setting and optional written
       responses were accepted in order to protect anonymity, to encourage honesty
       and to respect that some individuals are reluctant to speak in a group.

All focus groups were facilitated by Judy Rojas B.S., C.A.S. Demographic data for this
report was obtained from program statistics gathered for the 2006-2007 SCADP Annual

Focus Group Overview

Focus groups #1 and #2 consisted of residents and staff from SCADP addiction
treatment programs in Los Angeles and Orange counties invited by the program director
to participate and verbally share personal experience, opinions, and beliefs. In the case
of the satellite groups, the program director attended a scheduled group session at the
invitation of the group facilitator.

Each group began with a brief overview of FASD and the P-CAP, followed by
introductions and a review of the focus group process. In each case, everyone was
encouraged to participate and reassured that all comments were valuable (no wrong
answers). In focus groups #1 and #2, the facilitator asked a question and then invited
each woman to answer before moving on to the next question. There were no time
limitations. Notes were taken by a non-group member who was introduced before
beginning the group session. In the satellite focus groups, the overview was followed
by introductions and a brief discussion before introducing the questions.

Focus Group #1—Residential Clients - consisted of eleven participants: eight female
clients of childbearing age (18-44) in residence at one of the addiction treatment
programs listed on the participant resource list and three female staff members. The
women were invited to participate in the focus group by the program director and were
advised that participation was strictly voluntary and confidential.

Focus Group #2—Case Managers/Counselors - was composed of female counselors
and case managers with extensive experience providing services to the target
population who were also in recovery. Ten staff members were invited, though only four
were present on the day of the focus group.

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The format for focus group #2 was similar to the focus group #1 format except that
participants were encouraged to share both personal experiences from their own
recovery as well as professional observations from their experience working with
women in substance abuse treatment. Again, each group member was given ample
time to answer each question, and a note taker, introduced at the beginning of the
session, was present.

Satellite Focus Group -- Program Director Judy Rojas met with a total of 23 women of
childbearing age (18-44) currently enrolled in either: 1.) La Casita - one of SCADP’s
residential addiction treatment programs, or 2.) Women’s Council - a gender-specific
outpatient substance abuse counseling program located in Downey, California. Ms.
Rojas explained the purpose of the discussion and handed out written questions for
participants to respond to either verbally or in writing.

As noted above, participants were given the option to respond in writing in case a client
was uncomfortable sharing personal information in a group setting. Participants were
selected on the basis of availability at the time of the focus group.

B. Assessment Questions

The questions this needs assessment was designed to answer are:

1.     What are the major influences in the target client’s life, including those that led to
       substance abuse and those that led to eventually seeking treatment?

2.     What needs are specific to the target group of women with children?

3.     What are the greatest barriers to seeking assistance?

4.     What are the target group’s behaviors, knowledge and attitudes relating to P-
       CAP goals and the risk of an alcohol-exposed pregnancy?

5.     What supportive services do pregnant and post-partum women need after
       leaving a residential facility?

6.     What resources will increase the probability that they will remain sober and
       practice effective forms of birth control?

7.     What supportive tools or services will provide advocates the best opportunities
       when working with P-CAP participants?

8.     What are the strengths and weaknesses of SCADP’s multi-site delivery system,
       and how can P-CAP best be integrated into our system?

Needs Assessment
The specific questions posed and answers provided in each focus group are detailed in
the Appendix 1 of this document. The specific questions posed to each focus group
were as follows:

Focus Group #1 Questions

      What things contribute to substance abuse among women?

      What do you see as the special needs of women and mothers to prevent
       alcohol/drug relapse?

      How do you think love relationships affect your life? Do they affect your ability to
       stay sober?

      What are your greatest concerns for maintaining sobriety after you leave

      What prevents women/mothers from accessing help?

      What would you consider useful and what would not be useful to provide in a
       support program for women and their children with new sobriety that could be
       provided by other women with strong, established sobriety?

      How important is culture in providing these services? What do you need in terms
       of culturally-sensitive services?

Focus Group #2 Questions

      What do you see as high-risk needs of women/mothers to prevent alcohol/drug

      What do you believe is most difficult in maintaining sobriety after a woman leaves

      What resources or tools do you believe would be helpful when working with

      What precautions do you believe a person should take when conducting home

      In order provide culturally-sensitive services, what can SCADP provide in terms
       of education to better gain an understanding of various cultures and how to work
       with them?

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      What potential issues do you believe may arise from a long-term home visit
       relationship with a client?

      What, if any, resistance have you met with when working with women?

    What advice or direction would you give a peer case manager who will do home
     visits for the first time?

Satellite Focus Group Questions (held at the treatment facility)

      How old are you?

      Before entering the program, would you consider yourself single or

      At what age did you start drinking alcohol?

      Are you pregnant, or do you suspect you might be pregnant?

      If you are pregnant, when is your due date?

      Is this your first child?

      Have you ever engaged in any alcohol use during pregnancy? (This includes
       before you found out you were pregnant.)

      How many days per week were you drinking?

      How many drinks per day were you drinking?

      At how many months of pregnancy did you stop drinking alcohol?

      What is your definition of one serving of alcohol (one drink)?

III. Results

A. Data about the population and analysis.

1. Data that helps describe and refine the population of interest.

The target population for this project is women from one of SCADP’s treatment
programs who are pregnant and up to six months post-partum. All of the women in
treatment have a substance abuse or dependency issue, and many have co-occurring
disorders of mental health and/or domestic violence. Six of the 26 women (26%) in the
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satellite discussion group were currently pregnant. Group participants were selected
based on availability at the time of the focus group and not on current pregnancy status.
SCADP does not have additional data on the number of pregnant women entering
treatment. Focus group responses by question are presented in Appendix 1.

Demographic data collected monthly at each treatment site and compiled in the 2006-
2007 annual report indicates that approximately 90% of the 400 women served through
SCADP residential facilities are homeless at the time of intake. Focus group data
indicates the majority of the women served at SCADP do not practice effective birth
control nor do they have adequate amount of information on the subject to make an
educated decision. Additionally, data shows that at some point in their lives, these
women have engaged in high-risk behaviors influenced by alcohol use. The average
age of the focus group women was 28 years.

                        Table 1: Client Race/Ethnicity (self-identified)
  Program          Latina    Caucasian African-       American Asian Other
                                          American Indian
Angel Step
Inn (ASI)                             No data collected
ASI Too            48%      17%        5%           6%          0%      23%
Awakenings         36%      31%        19%          0%          2%      11%
Bud       and      38%      48%        0%           0%          0%      17%
Casa Libre         94%      6%         0%           0%          0%      0%
Foley House        57%      31%        2%           1%          3%      5%
Heritage           40%      55%        5%           0%          0%      0%
House (HH)
HH North           29%      60%        4%           0%          2%      5%
La Casita          65%      24%        5%           4%          0%      1%
Positive           37%      38%        19%          0%          3%      3%

Data on clients’ drug of choice, homeless status and educational history are presented
in Tables 2, 3 and 4 respectively.

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                             Table 2: Client Drug of Choice
                                          Drug of Choice
  Program          Alcohol Methamphetamine Marijuana Cocaine Heroin   Other

Angel Step         25%    34%                 21%    15%     0%       6%
Inn (ASI)
ASI Too            10%    78%                 3%     6%      3%       0%
Awakenings         28%    21%                 13%    39%     0%       0%
Bud       and      13%    87%                 0%     0%      0%       0%
Casa Libre         17%    66%                 17%    0%      0%       0%
Foley House        3%     92%                 2%     2%      2%       0%
Heritage           4%     57%                 2%     5%      4%       28%
House (HH)
HH North           4%     53%                 1%     3%      4%       34%
La Casita          3%     51%                 3%     3%      0%       40%
Positive           15%    63%                 0%     18%     3%       0%

Table 3: Client homeless status
Program        homeless

Angel Step         100%
Inn (ASI)
ASI Too            100%
Awakenings         80%
Bud       and      100%
Casa Libre         100%
Foley House        96%
Heritage           72%
House (HH)
HH North           100%
La Casita          52%
Positive           34%

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                          Table 4: Client Educational History
                                 Highest grade completed
  Program          K-8    High        Trade      2-year     4-year Grad.
                          school      school     college    college School
Angel Step         20%    64%         2%         15%        0%      0%
Inn (ASI)
ASI Too            41%    55%          3%          0%           0%        1%
Awakenings         0%     82%          0%          9%           9%        0%
Bud       and      14%    86%          0%          0%           0%        0%
Casa Libre         73%    27%          0%          0%           0%        0%
Foley House        32%    55%          5%          6%           2%        0%

Heritage           20%    71%          3%          5%           2%        0%
House (HH)
HH North           38%    57%          0%          3%           2%        0%
La Casita          56%    36%          4%          4%           0%        0%
Positive           29%    67%          2%          0%           2%        0%

2. Data about how the population uses the services provided by the service delivery

Client’s complete one of the SCADP residential primary treatment programs within four
to six month programs. The average stay in a women’s residential facility is four
months, including those who do not complete the program. Transitional living programs
are from six to twelve months with a focus on education and job skills training.

Participants expressed that the SCADP residential treatment program provided an
environment that allowed them to ―connect‖ with other people who supported their
sobriety. They expressed concern about maintaining sobriety after graduation because
it would be difficult to maintain connections established in the treatment program and/or
create healthy new relationships with persons who would support their recovery.
Residential treatment is a safe and controlled environment designed to support healthy
relationships and help clients stay out of an intimate relationship that may be difficult to
manage emotionally. In women’s residential treatment, there is a strong emphasis on
developing parenting skills and creating support for successful parenting in order to
strengthen the relationships between the women and their children and to decrease
parenting stress.

In treatment, clients begin to learn about and work with feelings. In the focus group, a
client reported that ―feelings are difficult to work with,‖ conveying an awareness of the
challenge that emotions present to our target population. That awareness often begins
in treatment and develops throughout the program, but is increasingly hard to sustain as

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time passes outside of treatment without making the client too feel too emotionally

Residential treatment provides parenting skills education and daily parenting support.
Neither the mother nor the children are isolated in a residential program.

Residential treatment establishes and/or supports good working relationships with
DPSS in the CalWORKs or the GAIN program and provides an up-to-date referral list
developed especially to address the needs of women and children.

Program Case Managers provide a case management plan for clients in residential
treatment. Services include medical, dental, mental health and vocational/educational
training as well as educational support for the children and referrals for pediatric health
services, including care for children with developmental disabilities. Every SCADP
program has service partnerships with providers in the immediate community.
Counselors and clients work together to prepare a discharge plan that includes referrals
to needed services and permanent housing resources.

3. Data on the knowledge, attitudes, and intentions of the population related to the
project’s desired behaviors.

The data collected in the focus groups, especially in the satellite focus groups, reflect
the knowledge attitudes and intention of the population. Participants expressed an
awareness of ―feelings,‖ the need ―not to be judged,‖ and the need for ―accountability‖
and ―trust.‖

Participants expressed that the factors contributing to substance abuse in the target
group were:
    stress due to children
    guilt
    the availability and prominence of drugs in the surrounding community
    difficulty with relationships, especially family relationships.

In order to achieve long-term sobriety, participants expressed the need for:
     parenting support
     childcare services, including a baby-sitting support network.

The women reported insecurity in their parenting abilities. They felt they lacked
parenting skills and required more childcare support. Recognizing and maintaining
healthy and supportive relationships is difficult for them. They reported a lack of support
after leaving a residential treatment facility and the isolation that they feel without a
close support network.

Fear of rejection and fear of losing children or facing criminal charges prevented women
from requesting or accessing help.
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There is no official contraception education program in the residential treatment
programs. Our P-CAP program can provide education on methods of contraception and
education on the dangers of exposing a developing fetus to alcohol.

B. Other relevant information that provides insight into what may influence the
population or suggests factors that should be considered, such as:

1. Indicators of the types of activities or service characteristics the population may or
may not be willing to use or interested in using.

In this population of childbearing women, the need for quality childcare services was
repeatedly expressed. Possible support and networking in the form of a baby-sitting
support network was discussed. Child care concerns impact the development of
healthy peer support activities. For example, participants expressed a need for 12-step
meetings where childcare was available. Single women raising children don’t feel they
have enough support–either financial or emotional—as parents. Low-income families
spend an average of $373 a month – 24% of their earnings - on child care (Children
Now, n.d.).

Participants agreed that peer advocates will require intensive training in cultural
sensitivity and that advocates must remember boundaries, take the time to get to know
the person they’re working with, understand them and allow them to work at their own
pace. Participants expressed emotional sensitivity and the need for advocates to
respect the delicate state that they are in during and just after completing primary

Participants also suggested that advocates speak the family’s first language (e.g.,
monolingual Spanish) and have the capacity to communicate with extended family
members. Family involvement is very important to the Latin community, and the
majority of SCADP’s clients are Latino.

Regarding specific suggestions for P-CAP, participants suggested that P-CAP advocate
visits be limited to daylight hours and that advocate and client meet in an agreed-upon
place if the home environment presents any safety issues.

2. Referral sources and other services that clients use that may be relevant or that may
reinforce efforts of the service delivery organization.

Please see Appendix 2 for service partnerships for the women and children’s treatment
programs listed by program type.

3. People or institutions that can influence the population served, including staff.

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Clients expressed the importance of the NA and AA fellowship in maintaining their
sobriety: ―I need my sponsor to check in with me, to stay connected with me.‖ ―A good
[12 step] book study would help.‖ ―I know I need to go to meetings.‖ Connection with
self-help recovery groups is encouraged in the treatment programs with 12-step groups
often held on site. However, women have expressed a need for more extensive support
than the 12-step program to prevent relapse and maintain sobriety.

Participants express the need to stay connected with one another. ―That phone can be
sooo heavy sometimes. We need support to stay connected.‖ ―Use the sisterhood.‖ ―I
need to be able to come back to the program.‖

Any assistance with child care will increase the ease of daily living. ―For me, it’s finding
babysitting – again, back to that.‖ Without ongoing practice and encouragement to keep
boundaries and maintain emotional independence, the women are at high risk to re-
establish connections with their children’s father, based solely on the need for
assistance with the children. Aid with daily problem-solving independent of significant
others will decrease the likelihood for establishing and/or maintaining intimate
relationships that address practical needs but potentially increase emotional stress.

Some service institutions have impacted the clients negatively. When asked what
prevents women/mothers from accessing help, one woman responded:

       ―Judgmental people. I went in the hospital to give birth and they said I was
       positive for opiates. But it was the anesthetic! I was clean! Did they forget they
       gave me an anesthetic? The hospital judged me. I’m an addict – coming from a
       recovery program to give birth. Gotta call the authorities. They didn’t take the
       time to find out the truth. They just took the baby from my breast. They sent
       someone to the house where my little girls were staying and took them away too.
       In the middle of the night. Traumatized them. The baby was never able to nurse
       again because it was taken away. And it was all untrue. But I survived. I made
       it. That was a lesson for me…‖

The goal for staff is to provide positive, concrete, non-judgmental support and referrals
for several needed services for the women and their children. Staff also models positive
behaviors and successful sober living.

  4. Existing data that describes the problem of prenatal alcohol exposure.

Satellite group data revealed that women were not as conscious of alcohol intake as
they were of other substance use. The definition of ―one drink‖ ranged from ―a 12 oz.
beer‖ to ―a bottle (a 5th).‖ Though the percentage of women reporting alcohol as their
drug of choice ranged from 3% to 28% with an average of 12% overall, the average
reported age the women began to drink was about 12 years old, and 16 out of the 23
(70%) admitted to drinking during pregnancy.

Needs Assessment
Data reveals that in order to address P-CAP goals, our treatment programs will have to
provide more extensive information on alcohol and alcohol abuse. Women were not
aware of the health dangers alcohol presents to the fetus or even to their own bodies.

IV. Implications and Recommendations

A. Discuss the data in terms of refining the target audience, factors that influence the
target audience, and insights relevant to the development of the intervention and
integrating it into SCADP. Identify potential obstacles and opportunities to succeed.

In a group of 23 women assembled from two of the ten women’s residential treatment
programs, six of the 23 (26%) were pregnant. While we cannot count on such a high
percentage of pregnant women in our residential treatment programs at any one time,
the data confirms that we’re very likely to find our target population among the women
enrolling in our residential programs.

Though a small percentage of the focus group participants claim alcohol as their drug of
choice, 70% of the women surveyed reported that they drank alcohol while pregnant.
Drinking habits and frequency reported were moderate to heavy. Program emphasis is
often on abstinence from the drug of choice and alcohol is often a secondary drug.
While alcohol education is provided, it isn’t emphasized enough in our programs and
isn’t directly connected to women reproductive health issues. The matrix model is a
standard of relapse prevention that is used at many of the residential treatment
programs, women’s health issues and awareness of the effects of alcohol on a woman’s
body and on the fetus must be added to the curriculum. The most glaring need that
surfaced in our assessment and should be addressed by our P-CAP program is to
provide a more thorough and in-depth education about alcohol and its potential effects
on a fetus.

The P-CAP program can have significant impact here by first providing alcohol
education for women in residential treatment and then reinforcing that education during
home visits. P-CAP staff will work with residential staff members to assure that
education goals are supported throughout primary treatment and that information
provided to clients is consistent.
Because so many of these women are homeless, maintaining contact over the project
period of three years despite the overall instability of the population is an anticipated
challenge for the project. P-CAP advocates may have to be assertive in order to
maintain contact. The case management issues will include housing, and our team will
have to be prepared with housing resources. Housing in southern California is
expensive, and affordable housing is very hard to find. SCADP offers Shelter Plus Care
to program participants, but not all participants will be eligible for this program. Many
will have to be placed elsewhere. P-CAP staff will have to identify potential sources for
permanent housing and foster relationships between SCADP and that agency.

Needs Assessment
In addition to housing resources, P-CAP case managers will need to be equipped with
an up-to-date, comprehensive referral list designed specifically for women and children.
Maintaining a good relationship with Cal-Works and the GAIN program workers as well
as service providers in other facets, including health care and education, will enhance
the case managers referral capacities.

Concerns regarding significant-other relationships were prominent in the focus group
responses as an obstacle to client’s continuing recovery. Clients reported that although
they found relationships extremely difficult and a possible trigger to relapse, they would
often get into them in order to meet survival needs. The P-CAP advocate can have a
substantial impact here by modeling clear boundaries and proper respect for the client
and her children, as well as for herself. While developing the client’s skills and
capability for self- reliance, P-CAP provides an opportunity for a long term supportive
relationship that is likely to be unique and impacting in the lives of the client and her
child(ren). By developing the client’s ability to self-advocate, the P-CAP advocate can
minimize the client’s reliance on a significant other and promote relationship choices
that contribute to the client’s personal growth and independence. Risky relationships
aren’t conducive to maintaining a clean and sober lifestyle. Reinforcing positive and
healthy relationships will aid the client to make increasingly reasonable decisions about
using effective methods of contraception and prevent future alcohol-exposed

The SCADP P-CAP program can consider childcare availability a priority for the P-CAP
clients. Case Managers will have to develop resources and referrals for childcare
programs and financial aid/voucher programs to provide childcare. Reliable childcare
will allow clients to pursue further education or vocational training (SCADP’s own Next
Step Voc/Ed program will be available to our clients), find a job, go to 12 step meetings
and cultivate a sober support network.

Because the majority of our clients identify themselves as Latina, our staff will have to
be highly sensitive to cultural diversity and especially the specific concerns and
influences of the Latino culture. The ability to speak Spanish will be very helpful.
Cultural differences most definitely must be taken into consideration if trust and rapport
are to be established between client and advocate. Likewise, feelings must be
acknowledged and respected. The advocate will have to be mindful of where the client
is emotionally and meet them there.

Ultimately, P-CAP goals are to become the clients’ own goals and benefit society as a
whole. The possibility and probability of this happening -- the opportunities for this to
succeed -- will be strongly enhanced by the P-CAP program itself, not only by its
theoretical foundations and core components but also by the compassionate efforts,
supportive resources provided, experienced recovery and continuing relationship
cultivation between P-CAP’s advocate/case-managers as ―sober sisters‖ of their clients.

Needs Assessment
B. Provide the reasons FASD prevention is needed in SCADP.

Women enroll in SCADP’s residential treatment programs because they are ready to
seek help. 83% of the women in residential treatment last year were homeless. Most of
them have children, many of them have several children and many have open cases
with the Department of Children and Family Services. While in treatment, they learn to
communicate about support, recovery, stress, trust, emotions, and most of them work
hard to improve their parenting skills. They are generally eager for the education that
they receive, and if and when they graduate from one of these programs, the intention is
always to remain clean and sober. It’s a population ready and willing to receive and
share an education on their own substance abuse as well as their mental and physical
health. From the data collected in the focus groups, it’s clear that these women have
not been educated on either alcohol use and abuse or birth control. The data collected
for this needs assessment confirms that this population is extremely high risk for giving
birth to a child with an FASD. They fit the profile. Many of them have co-occurring
disorders. SCADP provides psychiatric assessment and treatment for this population
through other SAMHSA grants. The number of women (and children) entering a
program with PTSD is higher than the number of women with an official diagnosis.
Though this assessment doesn’t provide formal data on multigenerational use, most of
these clients report multigenerational use in their intake assessment.

Among the ―Facts to Consider‖ presented by Dan Dubovsky at the FASD prevention
kick-off meeting in March 2008, there is no known safe amount of alcohol to use during
pregnancy, there is no known safe time to drink during pregnancy, and most women do
not know when they are pregnant. The women from SCADP residential treatment
programs drank anywhere from one to seven days a week during their pregnancies;
some of them stopping during the first trimester, some the second with 31% continuing
to the third trimester and up to the birth. Providing this intervention and including
alcohol awareness education will have significant influence on the amount of alcohol
consumed during pregnancy and so impact the lives of these women and children.
SCADP’s proposed P-CAP program provides an opportunity to reach a concentration of
high-risk women and children and so impact the entire community.

Our target population has expressed the need for P-CAP by requesting ongoing support
and problem-solving assistance. The women in the focus groups repeatedly articulated
a desire for non-judgmental, consistent, long-term support when they leave residential
treatment. SCADP proposes to begin P-CAP while the women are in primary treatment
and to assist them to stay connected to each other and to their program throughout their
transition from residential care, and then through the first years of attempted sobriety.

More than 90% of the women SCADP served in 2007 are unemployed and receive
some sort of government assistance. In California, a woman with two young children
can receive up to $808 a month ($7,696 a year) through the CalWorks program
Needs Assessment
(Department of Employment & Temporary Assistance, 2007). This amount will not
cover childcare expenses in addition to food, shelter and other essentials. While there
is some supplemental assistance available for childcare when a woman is working or
attending school, the amount allotted prohibits any additional expense for services to
support long-term sobriety.

According to the data collected in focus group #1, there is a grave need for ongoing
services to support long-term stability in the face of stress and isolation. As women
assimilate back into their communities and a larger family structure, they encounter
unanticipated stress and dysfunction that often lead them back to drinking or abusing
other substances. Outpatient counseling services or other resources appear to be
underutilized. A residential treatment program will lay groundwork education in life
skills, parenting, stress management and relapse prevention, but daily maintenance of
those skills requires ongoing practice and continual support.

Focus group #2 asserted the importance of bilingual advocates and training in cultural
sensitivity and healthy boundaries.

Participant responses to written questions revealed the need for basic health education
and discussion to encourage and improve client awareness of their bodies and the
physical effects of substance abuse.

Needs Assessment

Children Now (n.d.). Child Care Arrangements in California. Retrieved May 28, 2008,

Department of Employment & Temporary Assistance (2002, December). PUBLIC
      ASSISTANCE OVERVIEW. Retrieved May 28, 2008, from

National Institute of Alcohol Abuse and Alcoholism (2005). Women and Drinking.
      Retrieved May 14, 2008, from

―Racial Disparities in Completion Rates from Publicly Funded Alcohol Treatment:
       ―Economic Resources Explain More than Demographics and Addiction Severity‖
       By Jerry O. Jacobson, Paul L. Robinson, Ricky N. Bluthenthal. Published in
       Health Services Research, v. 42, no. 2, Apr. 2007, p. 773-794.

Needs Assessment
                                        Appendix 1
            Southern California Alcohol and Drug Programs Inc.
                   Needs Assessment Report – Focus Group Data

Focus Group #1

Focus group #1 was composed of eight women (ages 18-44) who are currently enrolled
in residential treatment. Some of these women have been in treatment before, and a
few have lost children to the Department of Children and Family Services. When asked
what would help them reduce the possibility of relapse among women, the women gave
the following responses:

             Question                                Focus Group #1 Answers
What things contribute to substance     Inability to cope with children due to lack of child-
abuse among women/mothers?              rearing support.


                                        The area (neighborhood) one lives in.

                                        Relationships, and dealing with family.
What do you see as the special          Women need childcare services; a baby-sitting
needs of women and mothers to           support network.
prevent alcohol/drug relapse?
                                        There is a lack of support when one leaves a
                                        residential facility; women feel isolated.
How do you think love relationships     Relationships are difficult in early recovery due to
affect your life? Do they affect your   low self esteem.
ability to stay sober?
                                        Feelings are difficult to work with.
What are your greatest concerns for     Having the ability to connect with the ―right‖
maintaining sobriety after you leave    people.
                                        Finding balance between sobriety and other
                                        personal commitments.

                                        Being able to stay out of a relationship.
What prevents women from                Fear of rejection.
accessing help?
Needs Assessment
               Question                          Focus Group #1 Answers
                                     Fear of consequences such as losing children or
                                     facing criminal charges.
What would you consider useful       Data not available.
and what would not be useful to
provide in a support program for
women and their children with new
sobriety that could be provided by
other women with strong
established sobriety?
How important is culture in          People who speak the family’s first language are
providing these services? What do    important in order to communicate with all family
you need in terms of culturally-     members.
sensitive services?
                                     Family involvement is very important to the Latin

Needs Assessment
Focus Group #2. Case Managers/Counselors - female counselors and case managers
with extensive experience providing services to the target population who were also in
recovery. Ten staff members were invited, though only four were present on the day of
the focus group.

            Question                               Focus Group #2 Answers
What do you see as high-risk          The ability to work and/or qualify for childcare
needs of women/mothers to             services.
prevent alcohol/drug relapse?
                                      Staying connected with other women in recovery.
What do you believe is most           Childcare in general; finding 12-step meetings
difficult in maintaining sobriety     where childcare is available.
after a woman leaves treatment?
                                      Staying connected with the ―right‖ people.
What resources or tools do you        Maintaining good working relationships with
believe would be helpful when         CalWorks and the GAIN program.
working with women/children?
                                      Having an up-to-date, multifaceted referral list
                                      geared specifically for women and children.
What precautions do you believe       Visits should be limited to daylight hours.
a person should take when
conducting home visits?               Meet in a mutually agreed upon place if the home
                                      environment presents any safety issues.
In order to provide culturally-       All group members agreed that peer advocates will
sensitive services, what can          require intensive training in culture sensitivity.
SCADP provide in terms of
education to better gain an           Peer advocates should be encouraged to verbalize
understanding of various cultures     any questions or concerns.
and how to work with them?
What potential issues do you          Emotional attachments may become a challenge.
believe may arise from a long-
term home visit relationship with a   Training in both personal as well as professional
client?                               boundaries will be important.
What, if any, resistance have you     Nothing out of the ordinary in substance abuse
met with when working with            treatment: personal walls of defense or building
women?                                trust.
What advise or direction would        Remember boundaries.
you give a peer case manager
who will doing home visits for the    Take the time to know the person.
first time?
                                      Understand where the participant is at and allow
                                      them to work at their pace.

Needs Assessment
Satellite Group Discussion Questions and Answers: 23 women of childbearing
years (18-44) enrolled in either: 1) one of SCADP’s residential addiction treatment
programs, or 2) a gender-specific outpatient substance abuse counseling program
located in Downey, California.

            Question                                          Findings
How old are you?                      Ages ranged from 20 to 41; average age = 28.7
Before entering the program,          Out of the 23 women surveyed, 10 women
would you consider yourself single considered themselves to be single, 10
or married/cohabitating?              cohabitating, and 3 married.
At what age did you start drinking First use age ranged from 3 to 21 years old;
alcohol?                              average age of first use among the women
                                      surveyed was 11 years 8 months.
Are you pregnant or do you Six of the 23 women surveyed are currently
suspect you might be pregnant?        pregnant. Four are due within the next 6 weeks;
                                      one is 5 months pregnant; and one is 7 months
Is this your first child? (If this is Six women chose not to answer this question. Of
not the woman’s first child,          the 17 that did respond to the question, the number
participants were asked how           of children ranged from one to seven with an
many children they have).             average of two.
Have you ever engaged in any          Sixteen (70%) of the women surveyed admitted to
alcohol use during pregnancy?         alcohol use during any one of their pregnancies.
(This includes before you found       Of those denying any alcohol use, several admitted
out your were pregnant)               to engaging in illicit drug use - alcohol not being
                                      their drug of choice.
How many days a week were you Number of days a woman drank during the week
drinking? (during pregnancy)          while pregnant ranged from one day a week to
                                      seven days a week; the average was two days per
How many drinks a day were you Average drinks per day were 3.1; however, number
drinking?                             of drinks ranged from 1 to 12 per day.
At how many months (pregnant)         Five women reported that they did not drink during
did you stop drinking alcohol?        pregnancy, and two did not answer the question.
                                      Of the remaining 16 participants, 8 (50%) stopped
                                      drinking within the first trimester, 3 (19%) stopped
                                      during the second trimester, and 7 (31%) stopped
                                      during the third trimester or drank until the birth of
                                      the child.
What is your definition of one        Two women chose not to answer this question.
serving of alcohol (one drink)?       The answers of the remaining 21 participants
                                      varied widely. Answers ranged from ―one 12 oz.
                                      beer‖ to ―a bottle (a 5th).‖

Needs Assessment
                                         Appendix 2
                               REFERRAL GUIDE
Children Services
Mexican American Opportunity Foundation (MAOF)

International Institute of Los Angeles

Children’s Home Society of California (provides access to lending library for educational
material and toys)

Los Angeles Unified School District
      333 South Beaudry Ave.
      Los Angeles, California 90017

Rio Hondo Boys & Girls Club
      Bell Gardens, CA

General Community Support
AMASSI (African American Advocacy, support-services and survival institute events)
    160 S. La Brea Ave.
    Inglewood, CA

Fame Renaissance (provides bus tokens and taxi vouchers)
     1968 W. Adams Blvd.
     Los Angeles, CA

CHOC 24 hour baby hotline

     (323) 226-2622
     1200 N. State St.
     Los Angeles, Ca

Needs Assessment
Health (continued)
Roosevelt Healthy Start (student physicals and TB testing)
     (323) 780-6500

Whittier Health Center
       7643 Painter Ave.
       Whittier, CA

Long Beach Dept. of Health and Human Services (prenatal and pediatric care)
      330 Golden Shore Suite #20
      Long Beach, CA

Planned Parenthood LA
            560 South St.
             Los Angeles, CA

Options for Recovery (provides linkage to housing)
      1124 W. Carson St. Bldg. N-33
      Torrance, CA

Sisterly Love (provides transitional housing)
       523 W. 6th Street Suite #616
       Los Angeles, CA

Angel Step Too (SCADP Transitional housing)
      125 S. Boyle St.
      Los Angeles, CA

Cal-Works Homeless Families Project

OC Partnership
     139 S. Olive Street
     Orange, CA 92866
     (714) 288-4007 ext. 116
     (714) 288-1553 fax

Needs Assessment
Legal Aid
Legal Aid Foundation of Los Angeles
      110 Pine Ave.
      Long Beach, CA

DCFS provides education on the legal system, family law and individual rights.

Mental Health
Dept. of Mental Health

USC Medical Center

ENKI Boyle Heights

The Guidance Center (ages 2-18)

Portals (Los Angeles) provide comprehensive mental health services am\nd social
rehabilitation support to individuals with mental health illness.

Personal Identification
Birth Certificates
       4716 E. Cesar Chavez Ave.
        Los Angeles, CA

       (800) 777-0133

Social Security

Social Services
DPSS (cash aid, food stamps, and medical)
     4077 N. Mission Road
     Los Angeles, CA

Needs Assessment

Substance Abuse Centers
BHS Family Recovery Center

Oscar Romero Community Health Center

Plaza Community

SCADP (Drug and Alcohol Counseling Services)

Trauma Services
California Alliance against Domestic Violence / Angel Step Inn

SACA-Sexual Abuse Crisis Assistance

The Boys Town National Hotline is a 24-hour crisis, resource and referral line.

National Suicide Prevention Lifeline is a 24-hour, toll-free suicide prevention service
available to anyone in suicidal crisis.
       1-800-273-TALK (8255)

Needs Assessment

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